Operative Treatment of Hemorrhoids

Hemwell© Procedure

THD© Doppler Surgery

Excisional Hemorrhoidectomy

Fewer than 10% of all patients evaluated with symptomatic hemorrhoids will require surgical management. Most patients respond to non-operative treatment and do not require a surgical procedure. Hemorrhoidectomy, or surgical removal of the hemorrhoidal tissue, may be considered if a patient presents with symptomatic large external hemorrhoids, combined internal and external hemorrhoids, and/or grade 3-4 prolapse.  Hemorrhoidectomy is highly effective in achieving relief of symptoms and it is uncommon to have any significant recurrence.  However, it also causes much more pain and disability than office procedures and has somewhat more complications. Hemorrhoidectomy may be done using a variety of different techniques and instruments to remove the hemorrhoids and the particular technique is usually chosen based on a particular surgeon’s preference.  In basic terms, the excess hemorrhoidal tissue is removed and the resultant wound may be closed or left open.  Hemorrhoidectomy is performed in an operating room and may be done under sedation, general anesthesia, or under a spinal block (similar to an epidural injection during childbirth). In an attempt to avoid some of the postoperative pain associated with hemorrhoidectomy, a suture hemorrhoidopexy may be considered and involves pulling the hemorrhoids upward, returning the problematic hemorrhoidal tissue to its normal position. All operative procedures for hemorrhoidal disease carry their own set of risks and benefits and the ultimate choice of procedure must be made between you and your surgeon.  